Is the revision of a primary TKA really as easy and safe as the revision of a primary UKA?

Staats, Kevin; Merle, Christian; Schmidt-Braekling, Tom; Boettner, Friedrich; Windhager, Reinhard; Waldstein, Wenzel

doi:10.21037/atm.2016.11.01

Cited by 1 publication

(1 citation statement)

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“…9,10 The largest cost of PJI is to the patient as revision TKA compromises patients' quality of life and exposes them to a procedure with a higher complication rate (including deep infections), extended hospitalization, unsatisfactory functional outcomes, and a relatively shorter survival than primary TKA. 10,11 Given the significant clinical and economic burden associated with PJI, preoperative risk stratification for PJI following TKA is important for patient optimization, targeted prevention, and early diagnosis. To date, five studies have examined the prognostic value of elevated preoperative inflammatory biomarkers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), for developing PJI following TKA.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of idiopathically elevated ESR and CRP in patients undergoing primary total knee arthroplasty as a function of body mass index

Probasco

Cefalu

Lee

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used inflammatory markers utilized to aid in the diagnosis of periprosthetic infection (PJI). Patients with obesity, however, are known to have elevated baseline levels of these inflammatory markers. Therefore, this retrospective study aimed to determine the relationship between elevated ESR and CRP and body mass index (BMI) in patients undergoing total knee arthroplasty (TKA). In doing so, physicians can better determine whether BMI should be taken into account when evaluating the prognostic value of elevated preoperative ESR and CRP levels for risk of PJI in primary TKA patients. Methods: This is a retrospective case series of 181 patients who had undergone primary TKA at a single institution. Patients undergoing primary unilateral TKA were eligible unless they had undergone previous TKA, contralateral knee symptoms, or elevated white blood cell (WBC) count. A linear regression model was utilized to demonstrate the relationship between proportions of patients with elevated biomarker values and categories of BMI. Analysis of variance and independent two-sample t-tests were utilized to assess differences in mean ESR, CRP, and WBC levels between the "healthy patients" and "patients with comorbidities" subgroups within each BMI category. Results: Eligible patients (n ¼ 181) were stratified by BMI category. Elevated ESR was associated significantly with BMI (ESR: r 2 ¼ 0.89, P < 0.001) unlike elevated CRP (r 2 ¼ 0.82, P ¼ 0.133) and WBC count (r 2 ¼ .01; P ¼ .626). No statistically significant differences in ESR values and WBC count between the "healthy patients" versus "patients with comorbidities" were demonstrated within any BMI category. In patients of normal weight (BMI 20e25 kg/m 2 ), "healthy patients" had a statistically significantly higher mean CRP level than "patients with comorbidities" (1.73 mg/L vs. 0.70 mg/L, P < 0.001). There were no other statistically significant differences in mean CRP levels by health status. Conclusion: Caution is advised when utilizing ESR and CRP to diagnose periprosthetic joint infection without considering BMI given that increasing preoperative levels of ESR and CRP are correlated with higher BMI.

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